Individual
A SUE ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 MAIN ST, LAFAYETTE, IN 47901-1451
(765) 423-2638
Mailing address
610 MAIN ST, LAFAYETTE, IN 47901-1451
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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